Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction

Clements, Ian P.

doi:10.1016/j.ejheart.2004.06.005

Cited by 13 publications

(6 citation statements)

References 20 publications

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“…In addition, PER and PFR may vary widely from patient to patient due to patient selection or technical reasons [24]. Despite these limitations, the PER and PFR abnormal values assessed by other authors [25] and those observed in this study are significantly correlated. Our findings thus have a reasonable and consistent clinical validity.…”

Section: Discussionmentioning

confidence: 69%

Depressed Exercise Peak Ejection Rate Detected on Ambulatory Radionuclide Monitoring Reflects End-Stage Cardiac Inotropic Reserve and Predicts Mortality in Ischaemic Cardiomyopathy

Carboni

2012

Cardiol Res

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BackgroundFifteen patients with ischaemic cardiomyopathy and inducible ischaemia were studied to determine the mechanisms of mortality. Failure of the contractile reserve during daily life activities may reflect a prognostic index.MethodsSingle photon emission cardiac tomography and radionuclide ambulatory monitoring (Vest) data were analysed in all patients with a 7-year follow-up.ResultsAt peak exercise on Vest, the 7 non-survivors (N-SURV) showed worse peak ejection rates (PERs) and ejection fractions (EFs) compared with the 8 survivors (SURV), (2 ± 0.6 vs. 3.3 ± 0.7; end-diastolic volumes (EDVs), P < 0.003), and (34 ± 10% vs. 50 ± 13%; P < 0.02), respectively. However, exercise peak filling rates (PFRs) (1.9 ± 0.6 vs. 2.7 ± 0.9; EDVs/s) and exercise heart rates (HRs), (97 ± 17 vs. 106 ± 10), did not differ between the two groups (P > 0.05). In SURV, exercise PERs, which represented rapid left ventricular (LV) emptying, were significantly correlated with exercise PFRs, representing rapid LV filling, (r = 0.71, P < 0.04) but not in N-SURV (r = 0.66, P > 0.05). Among SURV, the Frank-Starling mechanism was thus preserved but not in N-SURV. Upon Cox analysis, overall LV function parameters, exercise PER was the only predictive measure associated with mortality (b = - 0.018, relative hazard ratio = 0.98, P = 0.02).ConclusionsExercise PER reduced values reflected failure of the Frank-Starling mechanism, the incapacity of the heart to perform rapid contractile adaptations to daily life activities and a poor prognosis.

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Section: Discussionmentioning

confidence: 69%

Depressed Exercise Peak Ejection Rate Detected on Ambulatory Radionuclide Monitoring Reflects End-Stage Cardiac Inotropic Reserve and Predicts Mortality in Ischaemic Cardiomyopathy

Carboni

2012

Cardiol Res

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“…Moreover, Bonow and colleagues demonstrated that in healthy patients, neither PFR nor the time to PFR correlated with echocardiographic LV end‐diastolic transverse dimension. Our results do not rule out the possibility that an increase in EDV is associated with a decrease in EF below normal limits because we included only patients with a normal EF in our study. Our results are in agreement with a recent study by cardiac magnetic resonance and by magnetic resonance spectroscopy of patients with stable diabetes mellitus, which reported an altered diastolic function and a decreased LVEF together with altered phosphocreatine metabolism in these patients compared with healthy controls …”

Section: Discussionmentioning

confidence: 81%

Left Ventricular Ejection Fraction and Left Ventricular End‐Diastolic Volume in Patients With Diastolic Dysfunction

Jovin

Liu

Finta

et al. 2012

Congestive Heart Failure

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3Diastolic dysfunction can be diagnosed on equilibrium radionuclide angiocardiography (ERNA) by a low peak filling rate (PFR) in the setting of a normal left ventricular ejection fraction (LVEF). The authors evaluated the relationship between diastolic dysfunction, LVEF, and enddiastolic volume (EDV). A total of 408 predominantly asymptomatic patients with an LVEF ! 50% by ERNA were studied. LVEF of patients with a low PFR was compared with the LVEF of patients with a normal PFR. Correlation analyses to evaluate the association between PFR and EDV were also performed. The LVEF of patients with a low PFR was lower than the LVEF of patients with normal PFR (59AE7 vs 63%AE7%; P<.01). There was no correlation between EDV and PFR (r=À0.04; P=.32). The results did not change when the EDV indices were used. In patients who had repeat scans, there was no correlation between the change in EDV and the change in PFR (r=0.16; P=.2). In asymptomatic patients undergoing ERNA who have normal systolic function, a low PFR can be associated with a lower LVEF, but it is not associated with changes in EDV. This suggests that diastolic dysfunction is associated with mild systolic dysfunction. ª2012 Wiley Periodicals, Inc.Diastolic dysfunction refers to abnormal mechanical properties of the myocardium and includes abnormal left ventricular (LV) diastolic distensibility, impaired filling, and slow or delayed relaxation-regardless of whether the LV ejection fraction (LVEF) is normal or depressed and whether the patient is asymptomatic or symptomatic.1,2 These diastolic abnormalities are usually present when systolic function is abnormal, but may also occur in isolation in persons with normal or near-normal systolic ventricular function. A recent population-based study reported a high prevalence (approximately 28%) of isolated diastolic dysfunction by echocardiogrpahy in a population older than 45 years, and its presence was associated with increased mortality. 3 The cause of this increased morbidity and mortality remains unclear.The ventricular relaxation abnormalities can be diagnosed by a low peak filling rate (PFR) on equilibrium radionuclide angiocardiography (ERNA) and correlate well with changes seen on Doppler echocardiography.4 Isolated diastolic filling abnormalities are frequently seen in patients with hypertension (HTN) and coronary artery disease 5,6 and are seen in patients undergoing chemotherapy. 7,8 We tested whether abnormalities in diastolic function are associated with changes in LVEF 9,10 or changes in end-diastolic volume (EDV) or both. Because heart failure with preserved ejection fraction (HFPEF) was first diagnosed using ERNA, the criteria for diagnosis are well established, even though today the diagnosis of diastolic dysfunction is more frequently made by echocardiography.11 Even though ERNA is still used today in situations where precise quantification of LV volumes (and ejection fraction [EF]) with high reproducibility is required, it has been supplanted by echocardiography (especially using harmonic imaging...

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“…Recently, the sequential connection of diastolic left ventricular dysfunction, atrial remodeling (atrial cardiopathy), AF, and left atrial thrombus has been emphasized. [31][32][33] Because a substantial portion of patients with diastolic left ventricular dysfunction have LVWMA with a normal ejection fraction, 34 LVWMA may be an early sign of heart failure from diverse etiologies. Echocardiographic parameters associated with LVWMA, including mildly decreased ejection fraction or decreased fractional shortening, have been demonstrated to have harmful effects on stroke.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular wall motion abnormality is associated with cryptogenic stroke

Choi

Cha

Jung

et al. 2019

International Journal of Stroke

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Background Left ventricular wall motion abnormality (LVWMA) unrelated to known cardiac risk factors is an uncertain risk for stroke. Aims We evaluated whether LVWMA was associated with cryptogenic stroke. Methods This retrospective, observational study included 4316 acute ischemic stroke patients, and the association between cryptogenic stroke and LVWMA was examined in comparison with other stroke subtypes. Results The prevalence of LVWMA was 10.0% in the study population. In a fully adjusted, binary logistic regression, LVWMA was independently associated with cryptogenic stroke compared with stroke from large artery atherosclerosis (odds ratio = 1.627, 95% confidence interval = 1.129–2.345), small vessel occlusion (odds ratio = 1.948, 95% confidence interval = 1.261–3.010), or other causes (odds ratio = 4.950, 95% confidence interval = 1.145–21.412). Meanwhile, the association of LVWMA with cryptogenic stroke was similar to the associations of LVWMA with cardioembolic stroke (odds ratio = 0.758, 95% confidence interval = 0.525–1.094) and stroke with two or more causes (odds ratio = 0.992, 95% confidence interval = 0.609–1.615). In multinomial regression, LVWMA had the strongest association with cardioembolic stroke, followed by cryptogenic stroke and stroke from two or more causes. The strength of the associations with LVWMA then decreased sequentially in patients with large artery atherosclerosis, small vessel occlusion, and other causes. Conclusions The association of LVWMA with cryptogenic stroke was comparable to that of LVWMA with cardioembolic stroke but stronger than that of LVWMA with non-cardioembolic stroke. LVWMA unrelated to known cardiac risk factors could be considered an independent risk factor for cryptogenic stroke.

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Combined systolic and diastolic dysfunction in the presence of preserved left ventricular ejection fraction

Cited by 13 publications

References 20 publications

Depressed Exercise Peak Ejection Rate Detected on Ambulatory Radionuclide Monitoring Reflects End-Stage Cardiac Inotropic Reserve and Predicts Mortality in Ischaemic Cardiomyopathy

Depressed Exercise Peak Ejection Rate Detected on Ambulatory Radionuclide Monitoring Reflects End-Stage Cardiac Inotropic Reserve and Predicts Mortality in Ischaemic Cardiomyopathy

Left Ventricular Ejection Fraction and Left Ventricular End‐Diastolic Volume in Patients With Diastolic Dysfunction

Left ventricular wall motion abnormality is associated with cryptogenic stroke

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